Published on Apr 19, 2019 - 2 min read
Patient counseling is an art, which every doctor should be skilled at. Every patient is different and the art of convincing the patient to take the right treatment is a challenge which depends upon multiple factors.
Patient counseling is an art, which every doctor should be skilled at. Every patient is different, and the art of convincing the patient to take the right treatment is a challenge which depends upon multiple factors. Dynamics of patient counseling in our country differ significantly from the west. In the west, patient forms the most important aspect of clinical decision making, his or her right to be informed cannot be violated unless he or she is not medically fit to take decisions.
Despite the same principles being available on paper, they are seldom practiced here. In India, everybody is a decision maker, citing the reason that they know what is best for the patient. This role is taken usually by the doctor or the primary health care doctor or the relative who accompanies the patient to the clinic, or it could be a distant relative sitting abroad who may or may not have the required medical knowledge.
There are multiple well-researched guidelines for most of the cancers at a national and international level. Patient counseling is not only about mentioning the prognosis, discussing treatment options, and associated side effects, but expressing them in a manner that makes the patient and all accompanying members comfortable and convinced. The most important principle of counseling is convincing them that what you are saying is right. This sometimes implies hiding vital information from the patient on a special request or sometimes from the relatives. There are so many patients completing treatment without even being aware of their disease, prognosis, treatment risks, and benefits, only because of one relative who feels that it is best for the patient. Interestingly, this usually works, either the patient gets better, and the truth has less impact or the patient succumbs to the treatment or disease and the truth hardly matters.
Gaining faith of the patients and their relatives in such a scenario becomes more important than keeping them informed. Sometimes, the simplest of treatment decisions are not so simple or obvious from the patient or relative’s perspective. People believe what they want to believe, and this drives many patients towards second and sometimes third opinions. In this chain, it gets difficult for the doctors to get the right advice implemented. If a surgeon recommends against surgery, the perception is that the doctor might not be good, so let us take a second opinion from a better surgeon, who might not be a surgeon, to begin with. Amid mistrust and the concept that one doctor is better than another, we sometimes fail to do what is right.
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